Bone Marrow Edema as a Predictive Marker for Flipped Medial Meniscus Tears: A Retrospective MRI-Based Analysis

Moran, Dylan; Sabzevari, Soheil; Saroyan, Arthur; Cederman, Matthew; Helou, Matthew; Theirl, Elizabeth; Dobrin, Iulia; Kamen, Jordan; Lebaschi, Amir; Guettler, Joseph; Bicos, James

doi:10.22038/abjs.2026.91920.4163

Bone Marrow Edema as a Predictive Marker for Flipped Medial Meniscus Tears: A Retrospective MRI-Based Analysis

Articles in Press

Document Type : RESEARCH PAPER

Authors

Dylan Moran ¹

Soheil Sabzevari ²

Arthur Saroyan ¹

Matthew Cederman ¹

Matthew Helou ¹

Elizabeth Theirl ¹

Iulia Dobrin ¹

Jordan Kamen ¹

Amir Lebaschi ³

Joseph Guettler ³

James Bicos ²

¹ Oakland University William Beaumont School of Medicine

² Corewell Health William Beaumont University Hospital

³ Corewell Health Beaumont Hospital

10.22038/abjs.2026.91920.4163

Abstract

Purpose:

Flipped meniscus tears (FMTs) are a distinct subtype of medial meniscal injury, characterized by displaced fragments lodged in the meniscotibial or meniscofemoral recess. Though MRI is key for diagnosis, subtle findings often hinder early detection. Bone marrow edema (BME), commonly seen in intra-articular trauma, has been proposed as a potential marker. This study evaluates whether BME on MRI can help predict FMTs compared to other medial meniscal tear patterns.

Methods:

We retrospectively reviewed 430 patients who underwent knee arthroscopy for symptomatic medial meniscus tears from 2013 to 2024 at a single academic institution. Exclusion criteria included advanced osteoarthritis, significant cartilage damage, and concomitant cruciate injuries. MRI findings, including presence and location of BME, were analyzed. Tears were classified as FMT or non-FMT and further categorized by acuity (acute vs. chronic) and mechanism (traumatic vs. atraumatic). Chi-square and Pearson correlation analyses assessed associations.

Results:

Of the 430 knees, 74 (17.2%) had FMTs, and 132 (30.7%) demonstrated BME. No significant associations were found between FMTs and BME presence (p = 0.441), or between BME and tear acuity (p = 0.480) or mechanism (p = 1.0). Although BME was more common in acute FMTs than chronic ones, this was not statistically significant (p = 0.308).

Conclusion:

BME was not significantly associated with FMTs, traumatic mechanisms, or tear acuity. Its absence should not exclude consideration of an FMT. Careful evaluation of tear morphology remains essential, regardless of BME.

Keywords

medial meniscus

knee arthroscopy

meniscal morphology

injury mechanism

Subjects